Medical (lack of) aid

You see, this has been a rather medical year for my little family, with one member undergoing chemotherapy for six months and another nearly dying of peritonitis. And so we’ve discovered what it’s like to be a fully-paid-up member of a medical aid.

As I wrote on Facebook: “Medical AID – what a misnomer!” (Except I included a rude word I can’t use on a family financial webpage.)

Because really, you know, aid is just what it isn’t. It’s nice, of course, to know that your major expenses like chemotherapy will be paid (if you go to the right service provider), but that’s what it’s all about, isn’t it, that’s what we pay the big bucks for every month.

Back when I started out in short-term insurance, this was how the purpose of insurance was defined: “that the burden which would fall heavily on the one falls lightly on the many”. Medical aid should aim to achieve the same effect, spreading the risk over many policyholders so that people who hit a crisis don’t have to worry about money.

Except they do, as we learnt. When peritonitis struck, we had no idea that our medical aid had recently binned a certain very big hospital group – one of us had had minor surgery just a few months earlier in the same hospital.

When we saw the surgeon, it was after 5pm – by which time all the wonderfully helpful people on the call centre have gone home. It was an emergency, of course, so the medical aid agreed to pay.

But they wanted to move the very ill person (umm, me) out of that hospital and into one of their choice the minute she left ICU. We had to agree to pay a third of the cost of the ward to avoid this. (Believe me, rattling off to a distant hospital at that point would have set back my recovery.)

When the family member on chemotherapy hit a wrinkle, the battle with medical aid commenced. We had a top medical professional motivating for essential tests, but would they authorise? Nyet!

Second-guessing medical practitioners is a medical aid habit, I found, on trawling through Hellopeter. A guy with a blinding headache ended up in ICU, for example, where viral encephalitis was diagnosed. Three months on, the medical aid is arguing about whether he should have been admitted to ICU.

Now I'm stuck having to worry where I'm going to get the money. Isn't this why we have medical aid? NOT to worry about things like this?

Hellopeter is full of similar stories. And if you just sit a while in a private hospital’s reception, you can find hundreds more: like Maureen, for instance, battling to get admitted because her top medical aid refused to accept her ENT’s decision that she was too ill to be at home and unmonitored.

Even I could see how ill she was, her coffee-coloured skin blotched and stained with huge, wine-coloured bruises that bagged out under her eyes. But a clerk on the other end of a phone said No…

The response from medical aids is often technically true: it’s not covered/your savings are exhausted/it’s excluded in terms of sub-clause 1 (iv) d. And we medical aid members feel like fools saying, “But I didn’t know!”

Well, why should I? I’ve yet to meet a medical aid policy which I can understand and remember all the detail of. I can’t memorise all the qualifications, footnotes and references back and forwards in the document, so that when a crisis hits, I can call to mind exactly what’s covered and what’s not – and what provider exactly I should opt for.

There is a distinct skills shortage here: we could increase customer satisfaction and boost productivity if medical aids (and other similar companies) engaged people who were trained as communicators to write their policies.

Next, there’s a shortage of basic office/clerking/computer skills. We’re not the only patients to have had a procedure authorised – by a clerk who presumably had our file open on the computer – only to have the medical aid back-track weeks later: “Your savings are depleted.”

Well, who was better placed to know that, you with the file open and all its history laid bare, panting to be read… or us phoning in from a waiting room, once more at the sharp and panicky end of a crisis?

And on that thought: heavens, people with a little training in sensitivity would be good! I know your bosses have told you that medical practitioners are lying cheaters, and so are the patients, but that’s simply not true (or only for a tiny minority).

Most of those who phone you from hospital wards and admissions desks and the waiting room outside the operating theatre just want the help we’ve paid for, in a time of terrifying, knuckle-whitening need. You could show a little compassion and understanding.

Try injecting some warmth and fellow-feeling into your voice when you tell them to choose between spending R7 800 they don’t have and knowing if their loved one has a dread disease.

And you know what? Learning a skill like that might actually make your job pleasanter.

 - Fin24

*Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own.